Body perception, awareness, and illusions

Anorexia Nervosa, Body Image Perception and Virtual Reality Therapeutic Applications: State of the Art and Operational Proposal

Anorexia Nervosa (AN) patients exhibit distorted body representation. The purpose of this study was to explore studies that analyze virtual reality (VR) applications, related to body image issues, to propose a new tool in this field. We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, EMBASE, Scopus, and Web of Science databases were explored; the review included 25 studies. Research has increased over the last five years. The selected studies, clinical observational studies (n = 16), mostly concerning patients' population with AN (n = 14) or eating disorders (EDs) diagnosis, presented multiple designs, populations involved, and procedures. Some of these studies included healthy control groups (n = 7). Studies on community sample populations were also selected if oriented toward clinical applications (n = 9). The VR technologies in the examined period (about 20 years) have evolved significantly, going from very complex and bulky systems, requiring very powerful computers, to agile systems. The advent of low-cost VR devices has given a big boost to research works. Moreover, the operational proposal that emerges from this work supports the use of biofeedback techniques aimed at evaluating the results of therapeutic interventions in the treatment of adolescent patients diagnosed with AN.

Challenging the Boundaries of the Physical Self: Distal Cues Impact Body Ownership

The unique ability to identify one’s own body and experience it as one’s own is fundamental in goal-oriented behavior and survival. However, the mechanisms underlying the so-called body ownership are yet not fully understood. Evidence based on Rubber Hand Illusion (RHI) paradigms has demonstrated that body ownership is a product of reception and integration of self and externally generated multisensory information, feedforward and feedback processing of sensorimotor signals, and prior knowledge about the body. Crucially, however, these designs commonly involve the processing of proximal modalities while the contribution of distal sensory signals to the experience of ownership remains elusive. Here we propose that, like any robust percept, body ownership depends on the integration and prediction across all sensory modalities, including distal sensory signals pertaining to the environment. To test our hypothesis, we created an embodied goal-oriented Virtual Air Hockey Task, in which participants were to hit a virtual puck into a goal. In two conditions, we manipulated the congruency of distal multisensory cues (auditory and visual) while preserving proximal and action-driven signals entirely predictable. Compared to a fully congruent condition, our results revealed a significant decrease on three dimensions of ownership evaluation when distal signals were incongruent, including the subjective report as well as physiological and kinematic responses to an unexpected threat. Together, these findings support the notion that the way we represent our body is contingent upon all the sensory stimuli, including distal and action-independent signals. The present data extend the current framework of body ownership and may also find applications in rehabilitation scenarios.

Vicarious pain is an outcome of atypical body ownership: Evidence from the rubber hand illusion and enfacement illusion

Some people report localised pain on their body when seeing other people in pain (sensory-localised vicarious pain responders). In this study, we assess whether this is related to atypical computations of body ownership which, in paradigms such as the rubber hand illusion (RHI), can be conceptualised as a Bayesian inference as to whether multiple sources of sensory information (visual, somatosensory) belong together on a single body (one's own) or are distributed across several bodies (vision = other, somatosensory = self). According to this model, computations of body ownership depend on the degree (and precision) of sensory evidence, rather than synchrony per se. Sensory-localised vicarious pain responders exhibit the RHI following synchronous stroking and-unusually-also after asynchronous stroking. Importantly, this occurs only in asynchronous conditions in which the stroking is predictable (alternating) rather than unpredictable (random). There was no evidence that their bottom-up proprioceptive signals are less precise, suggesting individual differences in the top-down weighting of sensory evidence. Finally, the enfacement illusion (EI) was also employed as a conceptually related bodily illusion paradigm that involves a completely different response judgement (based on vision rather than proprioception). Sensory-localised responders show a comparable pattern on this task after synchronous and asynchronous stroking. This is consistent with the idea that they have top-down (prior) differences in the way body ownership is inferred that transcends the exact judgement being made (visual or proprioceptive).

Increasing self-other bodily overlap increases sensorimotor resonance to others' pain

Empathy for another person’s pain and feeling pain oneself seem to be accompanied by similar or shared neural responses. Such shared responses could be achieved by mapping the bodily states of others onto our own bodily representations. We investigated whether sensorimotor neural responses to the pain of others are increased when experimentally reducing perceived bodily distinction between the self and the other. Healthy adult participants watched video clips of the hands of ethnic ingroup or outgroup members being painfully penetrated by a needle syringe or touched by a cotton swab. Manipulating the video presentation to create a visuospatial overlap between the observer’s and the target’s hand increased the perceived bodily self-attribution of the target’s hand. For both ingroup and outgroup targets, this resulted in increased neural responses to the painful injections (compared with nonpainful contacts), as indexed by desynchronizations of central mu and beta scalp rhythms recorded using electroencephalography. Furthermore, these empathy-related neural activations were stronger in participants who reported stronger bodily self-attribution of the other person’s hand. Our findings provide further evidence that empathy for pain engages sensorimotor resonance mechanisms. They also indicate that reducing bodily self-other distinction may increase such resonance for ingroup as well as outgroup targets.

Virtual reality in the treatment of eating disorders

Over the last 25 years, virtual reality (VR) has offered innovative solutions for targeting different key symptoms of eating disorders: from craving to negative emotions, from attentional biases to body dissatisfaction. The present narrative review assesses the existing literature in these areas trying to identify their different levels of clinical evidence. Specifically, the review presents four clinical approaches based upon VR and their implications in the treatment of eating disorders: VR cue exposure, VR reference frame shifting, VR for correcting body distortions and attentional biases. In general, existing findings demonstrate the clinical value of VR. On one side, the present review suggests that two VR-based techniques-VR exposure and reference frame shifting-have a significant research support and provide a possible advantage over traditional cognitive-behavioural therapy (CBT) for bulimia nervosa and binge eating disorder. On the other side, two emerging VR applications-multisensory body illusions and the use of VR for the modification of attentional biases-even if supported by preliminary data still need further research.

In your eyes: vision of the body alters touch perception in women with eating disorder symptoms

We investigated the effects of non-informative vision of the body on exteroceptive multisensory integration and touch perception in participants presenting with different levels of eating disorder (ED) symptoms. The study employed a sample of women reporting low (low ED; n = 31) vs high (high ED; n = 34) levels of subclinical ED symptoms who undertook the Somatic Signal Detection task (SSDT). During the SSDT, participants are required to detect near-threshold tactile stimulation at their fingertip with and without a simultaneous light flash next to the stimulated fingertip. Previous research has found that participants have a tendency to erroneously report touch sensations in the absence of the stimulation, and especially when the light flash is presented. In this study, participants completed the SSDT under two conditions: while their hand was visible (non-informative vision), and while their hand was hidden from sight (no vision). Non-informative vision of the hand was found to have a different effect on SSDT performances according to participants’ levels of ED symptoms. High ED participants were better able to correctly detect the touch during the SSDT when their hand was visible. Conversely, for low ED participants, vision of the body was linked to a greater effect of the light in inducing false reports of touch. We suggest that in those with high ED symptoms, vision of the body may exacerbate a predisposition to focusing on external rather than internal bodily information.

From the jungle to urban centers: body image and self-esteem of women in three different cultures

The aim of this study is to compare body image, body perception, body satisfaction, body-related self-esteem and overall self-esteem of women from three different cultural backgrounds. The survey covers a sample of 187 women, including 133 Germans, 31 Q’eqchi’, and 23 Colombians. Two groups (in Germany and Colombia) live in urban centers, while one group (in Guatemala: Q’eqchi’) is a jungle-based ethnic group descended from the Maya where the body perception was largely unaffected by media. The instruments used in this study are the Figure Rating Scale, the Body-Esteem Scale and the Rosenberg Self-Esteem Scale. According to the study, German and Colombian women prefer a significantly slimmer body and perceive themselves more critically than Q’eqchi’. There are no significant differences in body perception between German and Colombian women. Q’eqchi’ women do not have significantly higher body satisfaction than German and Colombian women. Although German women have significantly higher body satisfaction than Colombian women, Q’eqchi’ women have the highest body-related self-esteem on average. Colombian women in turn have a higher body-related self-esteem than German women. There is a positive correlation between body satisfaction with both body-related self-esteem and overall self-esteem in all three groups. In conclusion, the German and Columbian women living in urban settings look much slimmer, prefer much slimmer bodies and have lower body-related self-esteem, compared to jungle-dwelling Q’eqchi’ women in Guatemala.

Multisensory modulation of body ownership in mice

Body ownership is a fundamental aspect of self-consciousness that reflects more than the presence of physical body parts. As demonstrated by the rubber hand illusion (RHI), human brains construct body ownership experiences using available multisensory information. Experimental conditions similar to those that induce the RHI in humans have been recently adapted to induce the rubber tail illusion (RTI) in mice. Here, we show that the RTI is enhanced in both sexes of mice by repetitive synchronous stroking comprised of correlated visual and tactile stimulation of real and rubber tails compared to visual-only mimicked stroking conducted without tactile stimulation. The RTI also appears to be enhanced in female but not male mice by slow compared to fast stroking that reflects an interoceptive manipulation associated with affective touch in humans. Sex differences in slow stroking effects are exploratory and require replication in mice. Sex differences have not been reported for the RHI in healthy humans, but women rate slow stroking as more affectively pleasant compared to the ratings of men. Results suggest that the RHI in humans resembles aspects of the RTI in mice. Studies of mice may therefore provide neurobiological insights on evolutionarily conserved mechanisms of bodily self-consciousness in humans.

The Role of Age on Multisensory Bodily Experience: An Experimental Study with a Virtual Reality Full-Body Illusion

A growing body of evidence demonstrated that it is feasible to induce ownership over an artificial body to alter bodily experience. However, several uncharted aspects about full-body illusion applications need to be tackled before a complete exploitation of these methods in clinical practice. This work is devoted to explore possible individual age-related differences in shaping changes in body representations induced with a full-body illusion. A total of 40 women were divided into two different age groups according to the median of the variable age. Participants estimated the width of three different body parts (i.e., shoulders, abdomen, and hips) before the entire illusion was induced (baseline), and after the synchronous and the asynchronous conditions. Results revealed that 26-to-55-year-old participants were more resistant to changes induced by the bodily illusion, whereas 19-to-25-year-old participants underestimated their bodies after both conditions. The findings were discussed in terms of the literature exploring age differences in responses to bodily illusion, which could suggest a Bayesian mechanism underlying these individual differences.

The role of expectation in multisensory body representation - neural evidence

Sensory events contribute to body ownership, the feeling that the body belongs to me. However, the encoding of sensory events is not only reactive, but also proactive in that our brain generates prediction about forthcoming stimuli. In previous studies, we have shown that prediction of sensory events is a sufficient condition to induce the sense of body ownership. In this study, we investigated the underlying neural mechanisms. Participants were seated with their right arm resting upon a table just below another smaller table. Hence, the real hand was hidden from the participant's view and a life-sized rubber model of a right hand was placed on the small table in front of them. Participants observed a wooden plank while approaching - without touching - the rubber hand. We measured the phenomenology of the illusion by means of questionnaire. Neural activity was recorded by means of near-infrared spectroscopy (fNIRS). Results showed higher activation of multisensory parietal cortices in the rubber hand illusion induced by touch expectation. Furthermore, such activity was correlated with the subjective feeling of owning the rubber hand. Our results enrich current models of body ownership suggesting that our multisensory brain regions generate prediction on what could be my body and what could not. This finding might have interesting implications in all those cases in which body representation is altered, anorexia, bulimia nervosa and obesity, among others.

Embodied Medicine: Mens Sana in Corpore Virtuale Sano

Progress in medical science and technology drastically improved physicians’ ability to interact with patient’s physical body. Nevertheless, medicine still addresses the human body from a Hippocratic point of view, considering the organism and its processes just as a matter of mechanics and fluids. However, the interaction between the cognitive neuroscience of bodily self-consciousness (BSC), fundamentally rooted in the integration of multisensory bodily inputs, with virtual reality (VR), haptic technologies and robotics is giving a new meaning to the classic Juvenal’s latin dictum “Mens sana in corpore sano” (a healthy mind in a healthy body). This vision provides the basis for a new research field, “Embodied Medicine”: the use of advanced technologies for altering the experience of being in a body with the goal of improving health and well-being. Up to now, most of the research efforts in the field have been focused upon how external bodily information is processed and integrated. Despite the important results, we believe that existing bodily illusions still need to be improved to enhance their capability to effectively correct pathological dysfunctions. First, they do not follow the suggestions provided by the free-energy and predictive coding approaches. More, they lacked to consider a peculiar feature of the human body, the multisensory integration of internal inputs (interoceptive, proprioceptive and vestibular) that constitute our inner body dimension. So, a future challenge is the integration of simulation/stimulation technologies also able to measure and modulate this internal/inner experience of the body. Finally, we also proposed the concept of “Sonoception” as an extension of this approach. The core idea is to exploit recent technological advances in the acoustic field to use sound and vibrations to modify the internal/inner body experience.

Spatiotemporal processing of somatosensory stimuli in schizotypy

Unusual interaction behaviors and perceptual aberrations, like those occurring in schizotypy and schizophrenia, may in part originate from impaired remapping of environmental stimuli in the body space. Such remapping is contributed by the integration of tactile and proprioceptive information about current body posture with other exteroceptive spatial information. Surprisingly, no study has investigated whether alterations in such remapping occur in psychosis-prone individuals. Four hundred eleven students were screened with respect to schizotypal traits using the Schizotypal Personality Questionnaire. A subgroup of them, classified as low, moderate, and high schizotypes were to perform a temporal order judgment task of tactile stimuli delivered on their hands, with both uncrossed and crossed arms. Results revealed marked differences in touch remapping in the high schizotypes as compared to low and moderate schizotypes. For the first time here we reveal that the remapping of environmental stimuli in the body space, an essential function to demarcate the boundaries between self and external world, is altered in schizotypy. Results are discussed in relation to recent models of 'self-disorders' as due to perceptual incoherence.

Transforming Experience: The Potential of Augmented Reality and Virtual Reality for Enhancing Personal and Clinical Change

During life, many personal changes occur. These include changing house, school, work, and even friends and partners. However, the daily experience shows clearly that, in some situations, subjects are unable to change even if they want to. The recent advances in psychology and neuroscience are now providing a better view of personal change, the change affecting our assumptive world: (a) the focus of personal change is reducing the distance between self and reality (conflict); (b) this reduction is achieved through (1) an intense focus on the particular experience creating the conflict or (2) an internal or external reorganization of this experience; (c) personal change requires a progression through a series of different stages that however happen in discontinuous and non-linear ways; and (d) clinical psychology is often used to facilitate personal change when subjects are unable to move forward. Starting from these premises, the aim of this paper is to review the potential of virtuality for enhancing the processes of personal and clinical change. First, the paper focuses on the two leading virtual technologies - augmented reality (AR) and virtual reality (VR) - exploring their current uses in behavioral health and the outcomes of the 28 available systematic reviews and meta-analyses. Then the paper discusses the added value provided by VR and AR in transforming our external experience by focusing on the high level of personal efficacy and self-reflectiveness generated by their sense of presence and emotional engagement. Finally, it outlines the potential future use of virtuality for transforming our inner experience by structuring, altering, and/or replacing our bodily self-consciousness. The final outcome may be a new generation of transformative experiences that provide knowledge that is epistemically inaccessible to the individual until he or she has that experience, while at the same time transforming the individual's worldview.